STEPHEN GREGORY CLARK DO Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****00

License Status

NOT RENEWED

Business

Title

First Name

STEPHEN

Middle

GREGORY

Last Name

CLARK

Business Name

STEPHEN GREGORY CLARK DO

Original Issue Date

08/31/2017

Effective Date

08/31/2017

Expiration Date

09/30/2020

City

URBANA

State

Zip

61822

County

CHAMPAIGN

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021